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PHARMAC Information sheet

Inequalities in access to medicines

Access to medicine in New Zealand

The Pharmaceutical Schedule provides funded access to medicines for all New Zealanders. However, we know that there are groups of people who access medicines more readily than others, and groups that have comparatively low access. Some of the reasons for inequitable access may be financial (such as the cost of going to the doctor), geographic (how close people live to a doctor or pharmacy), awareness (knowing what medicines or health services are available), poor prescribing, or because the person prefers an alternative non-funded treatment (such as a herbal remedy or traditional medicine), or no treatment at all. Hospitalisations for asthma for yearfor year ending May 2007 Hospitalisations for asthma ending May 2007

18.00 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 0 - 4 Years Māori Paci c Island European 5 - 9 Years 10 - 14 Years 15 - 19 Years

What are we doing about it?

Promoting the responsible use of medicines (or ‘optimal use’) is one of PHARMAC’s statutory functions. We work closely with others in the health system to ensure campaigns aimed at limiting over, under and mis-use of medicines are effective.

One Heart Many Lives promotes awareness of cardiovascular Māori disease, New Zealand’s #1 cause of death. The campaign is Paci c Island particularly aimed at Māori and Pacific men, who die up to 14 years European earlier than other New Zealanders. One Heart Many Lives was a response to analysis showing high rates of heart disease, coupled with low uptake of cholesterol-lowering statin medicines, in some areas of New Zealand. The programme is run in partnership with District Health Boards and Primary Health Organisations to develop local solutions fit for local people. An early assessment of the campaign showed increased awareness of the factors that contribute to cardiovascular disease (poor diet, smoking, physical inactivity, obesity), an increase in referrals for Green Prescriptions, and a greater than average increase in prescriptions for cholesterol-lowering medication. Another Information Sheet (Optimal Use of Medicines) provides more information about our current campaigns.

Age group

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Using asthma as an example, our analysis shows that medicines usage is higher for European New Zealanders and much lower for Māori and Pacific peoples. At the same time, Māori and Pacific people have higher rates of hospitalisation. This illustrates how differences in usage patterns can contribute to health disparities among different population groups.

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PHARMAC Information sheet

Māori Responsiveness Strategy

PHARMAC’s Māori Responsiveness Strategy is designed to increase prescribing, uptake, utilisation and optimal use of medicines by Māori. The strategy was developed after extensive consultation with the Māori community, and guides us on how to best meet the needs of Māori. The six strategic goals are: • Incorporate Māori strategic priorities into wider PHARMAC work • Improve human resources • Improve ethnicity data collection and analysis • Improve our performance in negotiating with suppliers and assessing new drug applications • Improve our performance in informing Māori about available subsidised medicines • Improve Māori representation and participation. The Strategy has led to a number of activities that improve our responsiveness to Māori. There is now Māori representation on PHARMAC’s Board and in advisory bodies. We also have a dedicated team, Te Whaioranga, providing specific advice on Māori responsiveness and managing projects aimed at improving Māori use of medicines. PHARMAC’s Māori Use of Medicines programme - He Rongoa Pai; He Oranga Whanau - has a number of aspects all designed to help Māori better use medicines.

2007-2012 November 2007

Te Whaioranga

Pharmaceutical Management Agency

Executive summary

Te Whaioranga, PHARMAC’s Māori Health Action plan, outlines PHARMAC’s contribution to improving Māori Health over the next 5 years. PHARMAC’s contribution is one part of a suite of health solutions within the wider NZ Health sector.

The primary goal of Te Whaioranga is to ensure that Māori have access to subsidised medicines and have the knowledge to use these medicines safely and appropriately.

The key Māori Health related objectives for PHARMAC over the next 5 years include: • Delivering cost effective programmes that enhance access to and use of pharmaceuticals by Māori; • Developing enhanced performance metrics to improve Māori Health; • Improving internal policy and process to consider the impact on Māori health of new pharmaceutical investments; • Producing quality ethnicity data analysis to focus campaigns to improve outcomes, efficiency and effectiveness; • Improving internal responsiveness to Māori health issues; • Increasing stakeholder relationships across the sector; • Improving relationships with Iwi / Hapü and Māori Health organisations.

Māori Responsiveness Strategy Action Plan

Decision Criteria

We have nine Decision Criteria that we use to decide which medicines should be funded. One of these criteria – the particular health needs of Māori and Pacific peoples – is in place specifically to help reduce inequalities in access to medicines.

Te Whaioranga Te Whaioranga

The Māori Responsiveness Strategy provides the framework for establishing Te Whaioranga. The report “Implementing PHARMAC’s Māori Responsiveness Strategy (2006)” summarises several areas where PHARMAC could progress its approach to produce benefits for Māori. These include: - targeting resources at priority areas; improving the quality of information and processes upon which decisions are based; promoting awareness amongst Māori of subsidised medicines; monitoring utilisation of medicines; and PHARMAC continuing to develop and implement initiatives that support an ongoing commitment to Māori health outcomes. Te Whaioranga sets out the activities PHARMAC will undertake to achieve the strategic goals of the Māori Responsiveness Strategy over the next 5 years.

Te Tiriti o Waitangi The Treaty of Waitangi

Māori Responsiveness Strategy Action Plan

PHARMAC acknowledges2 the special relationship that exists between the Crown and Māori and recognises the articles of the Treaty of Waitangi expressed through the principles of Partnership, Protection and Participation. PHARMAC shall demonstrate its commitment to the Treaty of Waitangi through the following actions: Partnership – working together with Iwi, hapu, whānau, Māori communities and Māori organisations to develop strategies for Māori health gain through use of medicines. Protection – ensuring Māori enjoy the same access to medicines as non Māori to receive at least the same level of health whilst acknowledging and safeguarding Māori cultural concepts and values. Participation – involving and encouraging Māori participation at all levels within the health sector in planning, procurement, access and optimal use of medicines.

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Expectations of PHARMAC

As a Crown Entity, PHARMAC has a responsibility for improving whānau ora and Māori health through its statutory functions. PHARMAC’s role in the health sector is to manage the national Pharmaceutical Schedule on behalf of all District Health Boards. As well as performing its statutory function, PHARMAC considers Government priorities as outlined in legislation and government strategies when setting strategy and determining actions. These include: • • • • • • New Zealand Public Health and Disability Act 2000 New Zealand Health Strategy New Zealand Disability Strategy He Korowai Oranga – Māori Health Strategy, 2002 New Zealand Primary Care Strategy, 2001 Whakatataka Tuarua – Ministry of Health

2. PHARMAC Operating Policies and Procedures 2006

Māori Responsiveness Strategy Action Plan

3

PHARMAC is the Government agency that decides, on behalf of District Health Boards (DHBs), which medicines get subsidised so that they are more affordable for New Zealanders and available nationally. The subsidies PHARMAC sets are funded from a fixed budget that is part of DHB funding. PHARMAC also promotes the optimal use of medicines, carries out some procurement for DHBs, and manages special access programmes for some medicines. Information Sheets on various PHARMAC topics are available from our website: www.pharmac.govt.nz/patients/infosheets If you have specific areas of interest (such as consultations, committees or vacancies), visit our website and subscribe to news feeds in the area(s) of interest to you: http://pharmac.govt.nz/feeds

Contacting Us

Call us on 0800 66 00 50 (between 9am and 5pm, Monday to Friday), or on 04 460 4990 (between 8am and 5.30pm, Monday to Friday). Write to us at: PHARMAC, PO Box 10 254, Wellington – we respond to all letters Email us at enquiries@pharmac.govt.nz – we respond to all emails